Intracoronary Optical Coherence Tomography-Derived Virtual Fractional Flow Reserve for the Assessment of Coronary Artery Disease

Seike, Fumiyasu; Uetani, Teruyoshi; Nishimura, Kazuhisa; Kawakami, Hiroshi; Higashi, Haruhiko; Aono, Jun; Nagai, Takayuki; Inoue, Kentaro; Suzuki, Jun; Kawakami, Hideo; Okura, Takafumi; Yasuda, Kazunori; Higaki, Jitsuo; Ikeda, Shuntaro

doi:10.1016/j.amjcard.2017.07.083

Cited by 44 publications

(29 citation statements)

References 24 publications

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“…We previously reported that optical coherence tomography (OCT)-derived FFR, which was calculated using a basic fluid dynamics equation, had a stronger correlation with FFR compared with conventional image-based measurements. 14 We also developed a method to calculate IVUS-derived FFR (IVUS-FFR), which is calculated from an original fluid dynamics-based algorithm, for the assessment of myocardial ischemia. The aims of this study were to (1) investigate the relationship between wire-based FFR and IVUS-FFR; and (2) compare the usefulness of IVUS-FFR and IVUS-derived MLA for the functional assessment of CAD.…”

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confidence: 99%

Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia

Seike

Uetani

Nishimura

et al. 2018

Circ J

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Background: Fractional flow reserve (FFR) is widely used for the assessment of myocardial ischemia. Intravascular ultrasound (IVUS) is an intracoronary imaging method that provides information about lumen and vessel morphology. Previous studies on the expanded use of IVUS to identify functional ischemia have noted an association between anatomy and physiology, but IVUS-derived minimum lumen area (MLA) has a weak-moderate correlation with myocardial ischemia compared with FFR. We developed a method to calculate FFR using IVUS-derived anatomical information for the assessment of myocardial ischemia. The aims of this study were to investigate the relationship between wire-based FFR and IVUS-derived FFR (IVUS-FFR) and to compare the usefulness of IVUS-FFR and IVUS-derived MLA for functional assessment. Methods and Results:We retrospectively analyzed 50 lesions in 48 patients with coronary stenosis who underwent IVUS and FFR simultaneously. IVUS-FFR was calculated using our original algorithm and fluid dynamics. Mean percent diameter stenosis determined on quantitative coronary angiography and on FFR was 56.4±10.7 and 0.69±0.08, respectively. IVUS-FFR had a stronger linear correlation with FFR (R=0.78, P<0.001; root mean square error, 0.057 FFR units) than with IVUS-derived MLA (R=0.43, P=0.002).Conclusions: IVUS-FFR may be a more valuable method to identify myocardial ischemia, compared with IVUS-derived MLA.

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confidence: 99%

Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia

Seike

Uetani

Nishimura

et al. 2018

Circ J

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“…Nevertheless, compared to resting Pd/Pa, the iFR was more sensitive to the difference in the severity of stenosis [44]. Similar to QFR, the virtual FFR derived from imagings including coronary computed tomography angiography (CCTA) [47], intravascular ultrasound (IVUS) [48], and optical coherence tomography (OCT) [49] combines the anatomical and physiological assessments without adverse effects from additional tests. Further results are awaited to determine the role of those techniques in detecting the physiological significance of coronary arteries.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Diagnostic Performance of Instantaneous Wave-Free Ratio versus Quantitative Flow Ratio for Detecting the Functional Significance of Coronary Stenosis

Zuo

Yang

Chen

et al. 2019

BioMed Research International

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Background. Fractional flow reserve (FFR), as a functional measurement of coronary stenosis, is recommended for guiding revascularization in intermediate coronary lesions. However, it still remains underutilized for potential reasons including time consumption, costs, or contraindications associated with adenosine administration. Here we performed this meta-analysis to assess the diagnostic performance of two adenosine-free indices, instantaneous wave free-ratio (iFR), and quantitative flow ratio (QFR) in evaluating coronary stenosis severity with FFR as the reference standard. Methods. PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to include relevant studies with the diagnostic accuracy of iFR or QFR referenced to FFR. A bivariate model was applied to pool diagnostic parameters. We used Cochran’s Q test and I2 index to assess heterogeneity and identify the potential source of heterogeneity by meta-regression. Results. A total of 8213 lesions from 28 studies (19 for iFR and 9 for QFR) were included in this meta-analysis. The pooled sensitivity and specificity were 0.79 (95% CI, 0.75 to 0.83) and 0.85 (95% CI, 0.82 to 0.87) for iFR and 0.90 (95% CI, 0.84 to 0.93) and 0.88 (95% CI, 0.86 to 0.90) for QFR, respectively. Significantly higher sensitivity and specificity were observed in the bivariate analysis for QFR than for iFR (P < 0.001 for both). The area under summary receiver-operating curve of iFR and QFR was 0.89 (95% CI, 0.86 to 0.92) and 0.92 (95% CI, 0.89 to 0.94). Conclusion. Evidence suggests that both of the two indices have good performance in detecting functional ischemia of coronary arteries and QFR might be a promising method without requiring the pressure wire. Further application of QFR may potentially provide important information to clinicians in the assessment of coronary lesions.

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“…The influence of lesion length on pressure loss across a stenosis is described by Poiseuille's and Bernoulli's law of fluid dynamics. The pressure gradient (Δ P ) is determined by the sum of viscous and separation losses, and it can be calculated by the following simplified equation: Δ P = FV + SV 2 ( F = 8 πμLA n / A s 2 , S = ρ /2[ A n / A s – 1] 2 ), where F is the coefficient of pressure loss due to viscous friction (FV) in the stenotic segment and S is the coefficient of pressure loss due to flow separation (SV 2 ) at the diverging end of the stenosis. Also, in this equation, μ is the absolute blood viscosity, L is the stenosis length, A n is the cross‐sectional area of the normal artery, A s is the cross‐sectional area of the stenosis segment, V is the flow velocity, and ρ is the blood density.…”

Section: Discussionmentioning

confidence: 99%

Differential influence of lesion length on fractional flow reserve in intermediate coronary lesions between each coronary artery

Shibutani

Fujii

Matsumura

et al. 2019

Cathet Cardio Intervent

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Objectives: This study evaluated whether the influence of lesion length on functional significance is similar between each target artery.Background: In the presence of a similar moderate degree of stenosis, the fractional flow reserve (FFR) in the left anterior descending coronary artery (LAD) is more often <0.80 than in the other arteries. Methods: A total of 221 lesions with intermediate stenosis on coronary angiography that underwent FFR measurement for the evaluation of myocardial ischemia were enrolled. Quantitative coronary angiographic analysis including percent diameter stenosis and lesion length was performed. The area under the receiver operating characteristics (ROC) curve was estimated for the best cutoff value as a predictor of FFR value of ≤0.80 for each coronary artery.Results: Although lesion length was similar among the lesions with an FFR >0.80 at different locations, the mean lesion length was significantly longer for lesions in the right coronary artery (RCA) with an FFR ≤0.80 than for those in the LAD and left circumflex artery (13.4 ± 3.4 vs. 8.6 ± 3.1 vs. 12.0 ± 3.7 mm, p < .001). ROC analysis demonstrated that the optimal cutoff value of lesion length for predicting an FFR ≤0.80 was 10.0 mm in the LAD (0.56 area under the curve [AUC], 48% sensitivity, and 76% specificity), whereas 13.1 mm in the RCA (0.84 AUC, 67% sensitivity, and 93% specificity). Conclusions:The impact of lesion length on myocardial ischemia is different for each coronary artery. A longer lesion length is required in the RCA than in the LAD to achieve an FFR ≤0.80. K E Y W O R D S catheterization, coronary angiography, fractional flow reserve

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Intracoronary Optical Coherence Tomography-Derived Virtual Fractional Flow Reserve for the Assessment of Coronary Artery Disease

Cited by 44 publications

References 24 publications

Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia

Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia

Meta-Analysis of Diagnostic Performance of Instantaneous Wave-Free Ratio versus Quantitative Flow Ratio for Detecting the Functional Significance of Coronary Stenosis

Differential influence of lesion length on fractional flow reserve in intermediate coronary lesions between each coronary artery

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